Mohs Surgery: What to Expect During the Procedure

Last week we discussed "Questions to Ask Your Doctor About Mohs Surgery " for those of you who may be preparing to have this type of surgery. As a quick review, Mohs Surgery is a popular procedure to remove basal cell and squamous cell skin cancers, particularly from the facial area. One reason for its popularity is the high cure rate. Most patients will enjoy hearing the statistics provided by The American Society for Mohs Surgery
that five year cure rates approach 99% for new cancers and 95% for recurrent cancers. Another plus to this type of surgery is that you will not need to spend time waiting at home for biopsy results as your doctor will look at the skin tissue right then and there to determine that the entire skin cancer has been removed. In addition the procedure is usually done on an outpatient basis using only local anesthesia. Nevertheless it can be quite anxiety provoking to know that you will be having surgery.

In this post we will talk about what you can expect to happen during the procedure itself. Your doctor will give you information about your surgery before the day of your procedure. Make sure you ask any questions of your doctor that you have at this time. While the specifics of your surgery may be different depending upon your surgeon and the size and type of skin lesion you have, there are some common things you can expect to happen during your procedure.

Prior to your surgery you will probably have to list all the medications you use and this also includes any vitamins or herbal supplements. Make sure to tell you doctor everything you are taking so that they can tell you which things are safe to take before your surgery.

The procedure generally takes 3-5 hours but sometimes it can be an all day affair. Some skin cancers may take longer because there are roots which grow deep under the skin. Your doctor will take the time to get all the skin cancer, roots and all. There will be some long waits as your doctor takes a look at the skin tissue under a microscope. Some doctors suggest that you bring reading material and/or a friend or loved one with you to help pass the time.

You may wonder if it will hurt. You will be given local anesthesia to numb the area before your doctor removes the skin lesion. Most people report that the procedure does not hurt much if at all. When I had interviewed member Gemma from Skin Cancer Connection, she told us that the procedure was relatively painless.

After being numbed, your doctor will remove the cancerous skin in a thin layer. Bleeding will be stopped with a cautery device. The wound will be dressed and bandaged and then you wait for the excised skin tissue to be made into microscopic slides. Most brochures on Mohs surgery will say that this slide preparation can take up to an hour or more. If your doctor examines the slides and finds that there is more cancer, he or she will repeat the procedure of excising more skin tissue. Most surgical practices report that on average it will take two to three excisions to remove all the cancer.

Depending upon the defect left from your surgery, some options for repairing the wound include: Allowing the wound to heal on its own, your doctor stitching the wound closed, or having a reconstructive surgeon close the wound. Discuss these possibilities with your doctor.

Your doctor will provide instructions of how to care for your wound and also what to do during an emergency. A follow up appointment will most likely be scheduled.

Some doctors will recommend that you avoid strenuous activities during your recovery time following your surgery. You may also be advised that it is possible to experience swelling, redness and/or bruising during the healing process.

In all likelihood your Mohs surgery will go well and you can feel fairly confident that your doctor will have removed all of the skin cancer. Remember to ask any questions of your doctor before you leave their office about the healing process as well as how to minimize your scar.

Here are some additional resources and information about Mohs surgery: